Question:

Thank you replying so quickly, Dr. Garcia. A few follow-up questions: Is it most likely that the infection is contaned to the implant only and hasn't infected the bone itself? If the bone is infected, will it have to be removed too? And in any case, shouldn't we just wait to see if the IV antibotics work before any surgery is attempted? If the implant has to be removed, can a new implant be placed so that my face will be symmetrical? If so, when? Thank you very much for your time and care.

Answer:

It is doubtful that the bone itself is infected. It is always wise to see if a non-surgical option will work, so yes, move forward with the IV antibiotics. If the implant is removed, I would wait at least 3 months before replacing it. Hope that helps.

Question:
Answer:

Infected Medpor implants can be removed. It is more tedious than removing silicone implants but with careful dissection, they are able to be released from the tissues and removed.

Question:

Good day, Dr. Garcia. Last week I had a chin implant trimmed through a small submental incision. Since then, my speech has been noticeably impaired. How likely is it that my surgeon damaged the mentalis nerve in this procedure? He tells me it's just swollen, but it feels quite different to me than it did before the surgery, like my chin is in vise. Oddly, and unexplainably, my upper lip is also numb. What do you think is going on? Thank you for your time and care.

Answer:

injury to the mental nerve is a possibility, but the nerve, rather than cut, can also be stretched, or affected by the local anesthesia if used. If the nerve is cut or injured you could see that when you purse your lips or smile and look in the mirror. If it was injured by stretching, the function will return in time, but it can take a number of weeks depending on how badly stretched it was. I really have no answer for the upper lip numbness unless he injected the area where the nerves to the upper lip are, but I see no reason for that if the only incision was going to be submental. I think you should go back to the office and have them check everything for you.

Question:

I had Medpor mandibular implants placed about 8 years ago. My surgeon and I agree that the angles (lateral to the chin) are too wide for a female face, so he plans to trim them conservatively. I am 54 years old. He claims that doing this will not cause the skin to sag, giving me jowls, which I really, really don't want. He says the skin will shrink, especially since he is trimming just a few millimeters. Is that right?  I'd rather have a wide jaw than jowls. Would you please advise before I proceed? Thank you, Dr. Garcia.

Answer:

I believe that since it is a small amount and the muscles in that area should allow the tissues to reattach to the Medpor implant, that you should be OK with what the surgeon has proposed.

Question:

Do you use tear trough implants in your practice for the groove in the infraorbital rim, next to the nose ? For years, I've tried both fat grafts (which didn't last) and HA fillers, which are, by definition, temporary and which yield variable  results. In your experience, what are the implants' relative advantages and disadvantages? Thank you.

Answer:

I have only done a few in all my years. They work well for boney problems where the bones are too flat, but they are poor options for tear torugh dark circes as that is more due to loss of fat or small amount of fat to begin with. The implants also will never conform to the area that needs filling as well as a filler can. We usually see 8-12 months on our filler patietns for tear troughs though.

Question:

Okay, so the sum of research on this misalligned fascia graft in my radix area, is that removing the graft  is doable, but the scar tissue left behind may leave me with some contour irregularities.
My question is, will I have more scar tissue the longer this has been left in? (only been 3 weeks)
 

Answer:

Irregularities can occur from scar tissue, that is correct.The amount of scar tissue that is created is not affected too much by the time the graft has been left in place. Understand also that whatever appearance was there for which the graft was placed will re-appear when the graft is removed.

Question:

Thank you so very much for your thorough answer, Dr. Garcia. The facial nerve center I went to had 6 surgeons who do that nerve transfer surgery review my case, and it was their collective opinion that I was not a good candidate for it. They felt that it could leave me with more damage than I currently have, since at rest, it isn't presently noticeable. They feared that I could end up looking like a stroke victim all the time, not just when I move.  I suppose I could try to get another opinion, but I fear that they may be right. What do you think? Is that surgery risky enough to make my damage worse or is it more likely to do nothing--unless it actually works and provides some improvement? After my devastating experience with one of the "world's leading experts in facial implants," I am obviously reluctant to make matters worse. What would you do if you were in my position? Thank you for your kindness and your time.

Answer:

I do not see what more damage the removal of the implant could cause besides the loss of volume with its removal and therefore asymmetry to the other side. I might suggest another opinion. I am sure they see the case as having a high risk and they do not want to add their names to the list of surgeons involved in something that went bad, but there has to be a level of mutual understanding so they would feel more inclined to do the work. I think they are just being malpractice-careful. Get another opinion.

Question:

A few years ago I had small cheek implants placed. There was instant nerve damage on one side. I can't raise the corner of my mouth/smile, scrunch my cheek, or completely close my eye on that side. My face hasn't drooped so in stasis, I look (sort of) OK, but with the slightest animation of my face, I look like I've had a stroke. In fact, that's what I tell people happened to me. I am asked about it every day.  Perhaps most devastating, I have corneal damage as a result of the nerve damage. My surgeon claims that he didn't transect the nerve and that he has never caused any nerve damage 30 years of practice. For the first year of this, he gave me the standard "wait and see" line -- that the nerves had just been stretched, etc. and that I would regain function. After a year, I went to a facial nerve center at another major teaching hospital and had an EMG. It revealed no electrical activity on that side of my face. The staff there told me, of course, that I had had a 3-6 month window post-op to have had this injury repaired if the nerve had been transected but by then, of course, it was too late. I went back to my surgeon (to whom other surgeons around the world refer complicated cases like mine!) and he said it was likely a nerve compression. Furthermore, he insisted that it was my fault 1) for having elected the surgery in the first place though he himself had recommended it because my mid-face was indeed extremely concave (this assertion added deep shame to my already considerable suffering) and 2) for likely not having taken care of myself post-op and that I had allowed excessive scar tissue to build up internally, causing the nerve compression myself, which is patent nonsense.  My surgeon is chief of facial plastics at one of the world's best known teaching hospitals. I know that not compromising nerve function is a particular point of pride and reputational competence for plastic surgeons, but I suspect he severed the nerve and that it is not compressed; but whether or not he did, both he and the surgeons at the facial nerve center think it would be dangerous to remove the implant. My question for you is this: If the nerve is compressed and not severed, wouldn't removing the implant reverse the compression, opening that neural pathway again? And if the nerve was severed and we removed the implant, would I be any worse off? Isn't it worth trying to remove it to see if the nerve could be de-compressed? I apologize for the length of this question, but I wanted to give you some context. Thank you for listening to my long tale of woe and to so many, many others who write to you. May God bless you for your exceptional  compassion and professional generosity, Dr. Garcia. 

Answer:

I am afraid that after this much time, the difference between compression and transection are not large. The nerve gets its blood supply from the periphery of the nerve and that is where the compression starts. If it was compressed by this time the nerve has likely died from lack of blood supply. Removing the implant likely will not help this far out as the 'damage' has been done . I do think contacting surgeons that do nerve transfers/ transplants is a worthwhile thing for you to do. What is done in this case is as small nerve is taken from elsewhere in your body, a non-essential nerve. The proximal or live end of the nerve is then attached to this transplanted nerve and the other end is attached to the nerve past the compression. The transplanted nerves serves as a conduit and the nerve can regrow through this channel. They do it for facial reanimation after accidents in people. Julia Terzis was the world authority but there are others out there now that do them. I think that is likely going to be your best option. It will take likely a year or more for the nerve to grow, but it will give you that as a possibility. I wish you the best, hope that helps some.

Question:

 Well, it has happened. A bridge too far. I saw some photos of myself the other day and nearly fainted. I look truly plastic and "done" in them in a way that I don't live and in animation. I've not had anything drastic done but the cumulative effects of a little here and a little there over a decade have added up to a LOT of som'in som'in: mini cheek-lift, small Medpor cheek implants, an upper bleph and -- I think this kicked me into the "done" category -- micro-pigment to thicken my eyebrows which were overdone two years ago and now have that terrible drawn-on look. I've also been getting 26 units of Botox to my glabella for 15 years, but I don't think that's the culprit. Anyway, yikes! I'm in Joan Rivers territory and hadn't realized it. I'm 60 and the photos make me appear almost embalmed.My family members told me a while ago that I look plastic, but I couldn't see it. The only thing I can undo at this point is the cheek implants, but the surgeon who placed them 9 years ago advised me not to remove them because 1) there's a significant degree of tissue in-growth at this point and I'd be left with a lot of tissue damage and badly sunken, uneven cheeks if they were removed and 2) he compressed the right sided of the buccal branch of my facial nerve when he placed them leaving the right side of my face about 50% paralyzed; he's nervous about further nerve damage, understandably. So, what to do? Continue living with this, I guess. Can you suggest anything about the micro-pigment? I can't laser it off without removing the sparse hair of my eyebrows. I know it's supposed to fade a bit over the years, but it's as dark and prominent as it was when it was first tattooed on. It almost looks like it was drawn on with a Sharpie. What a mess I have made of myself. I guess I'm a cautionary tale for your readers: Beware of small, tiny tweaks (note: all my procedures were done in-office with just local anesthesia) -- they add up! Thanks for "listening" and for making any suggestions you can.

Answer:

The eyebrow hair loss with laser tattoo removal is temporary and I think that is the best place to start. I do agree that removing the Medpor implants is probably not a good idea, especially with your prior history. Besides that, without seeing photos, I am not able to offer anything more, sorry.